Provider Demographics
NPI:1356108278
Name:WOOD, LAURA ANNE
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:WOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:ANNE
Other - Last Name:WILFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 RIVER RD APT 405
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1916
Mailing Address - Country:US
Mailing Address - Phone:862-357-2797
Mailing Address - Fax:
Practice Address - Street 1:2 RIVER RD APT 405
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-1916
Practice Address - Country:US
Practice Address - Phone:862-357-2797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND12929133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered